Nutrition; Your Pregnancy Matters
Bariatric surgery and pregnancy: Answers to patients' FAQs
April 28, 2020
The healthier you are at the beginning of pregnancy, the better your chances are of having a healthy pregnancy and baby. A key factor is achieving a healthy weight – both for you and your partner.
For some patients, losing 10 or 20 pounds with exercise and a better diet is enough to improve health. But if you battle obesity, the process of losing weight might not be so straightforward.
If lifestyle changes or weight loss medication haven't worked for you, your doctor might recommend that you consider bariatric surgery before becoming pregnant. More than 80% of bariatric procedures are in female patients. And approximately half of these are in women of reproductive age.
Research suggests that weight-loss surgery can improve fertility and protect women and their babies from obesity-related risks during pregnancy, such as:
- Gestational diabetes
- Premature birth
- Need for cesarean section (C-section) delivery
With the support of an expert team, most patients can have healthy pregnancies after bariatric surgery.
At UT Southwestern, patients have access to a team of specialists, including bariatric surgeons, nutritionists, and Ob/Gyns overseeing their care. UT Southwestern’s Frisco campus is the newest location in the Metroplex to offer bariatric surgery. These teams collaborate to help women overcome obesity and achieve happier, healthier lives during and after pregnancy.
There are a lot to of benefits and risks to consider. I’ve asked my colleague, Melanie Hafford, M.D., Director of Bariatric Surgery at our Frisco campus, to answer common questions about how bariatric surgery can affect fertility and pregnancy.
How does obesity affect fertility?
It's not uncommon for my Ob/Gyn colleagues to refer patients whose obesity is causing infertility. In women, obesity has been shown to triple the risk of infertility.
Menstruation requires a fine hormonal balance. Many hormones are produced and stored in fatty tissue. When there is excess fatty tissue, hormones levels can become abnormal, leading to reduced fertility. Obesity also increases a woman’s risk of developing polycystic ovarian disease (PCOS), which can cause irregular periods and infertility.
As you lose weight, these hormonal imbalances and other effects decrease. Data show that even a 5% reduction in weight when you’re obese can increase your fertility. If you still need help conceiving, losing weight can increase the odds that therapies such as in vitro fertilization (IVF) will be successful.
Although much of the focus on obesity and infertility is on women, it absolutely affects men as well. Obesity can lead to a drop in testosterone, which can cause infertility. Erectile dysfunction also is more common in men who are obese. In fact, obesity-related issues contribute to approximately 30% of couples' infertility concerns.
Who is eligible for bariatric surgery?
Bariatric surgery might be an option for weight loss in patients with a body mass index (BMI) of at least 40, or at least 35 with one or more obesity-related condition such as diabetes, high blood pressure, or sleep apnea.
There are two approaches to bariatric surgery:
- Restriction: This type of surgery physically limits the amount of food the stomach can hold. The most common of these procedures is a laparoscopic sleeve gastrectomy, in which 90% of the stomach is removed, leaving a much smaller, tube-shaped stomach known as a “sleeve.”
- Malabsorption: These surgeries are used to reduce the calories and nutrients the body absorbs. Examples of these procedures are a duodenal switch or laparoscopic Roux-en-Y gastric bypass, in which the stomach size is reduced and the intestines are rerouted.
How long does the full process take?
Bariatric surgery is not an instant fix. Most patients should expect the full process to take two to three years. This recommendation includes approximately three to six months of pre-surgery preparation, as well as 12 to 18 months of post-surgical weight loss. We generally recommend waiting 18 months to two years after surgery before trying to conceive to ensure overall nutrition is optimized for pregnancy.
UT Southwestern and other reputable centers typically require lifestyle changes in preparation for surgery, including diet and exercise modification and quitting smoking.
Several variables can affect the timeline. For example, some insurance policies require trying medical weight loss therapies for six months before proceeding with bariatric surgery. Other patients might have health conditions such as heart or endocrine complications to take care of before pregnancy.
What will happen to my body after surgery?
Most of your weight loss will likely occur within 18 months to two years after surgery. Waiting to conceive until this time passes will allow your nutrition levels to stabilize and give your body time to recover from some of the endocrine, cardiac, and vascular effects of obesity.
In this time, your monthly period will likely normalize as well. While it’s common for women who are obese to not have a period, that doesn’t mean you can't get pregnant.
During the waiting period, we will talk with you about birth control options. Because of potential decreased absorption after bariatric surgery, oral contraceptives might not work as well. Your doctor might recommend other options, such as an intrauterine device (IUD).
I’ve seen women shocked to become pregnant not long after bariatric surgery, particularly if they have been told in the past that they are infertile. If that happens, don’t panic. We’ll work more closely with your Ob/Gyn and nutritionist to ensure your nutrition levels are where they need to be to maintain a healthy pregnancy.
How might weight loss surgery affect pregnancy and delivery?
Protein, iron, folate, calcium, and vitamins B12 and D are common nutrient deficiencies after bariatric surgery. They also are important during pregnancy.
We’ll check to make sure your nutrition levels are appropriate throughout your pregnancy. We also might recommend certain nutritional supplements in addition to standard prenatal vitamins.
Weight-loss surgery shouldn’t affect labor and delivery and may actually decrease the risk of needing a C-section.
What are my next steps?
If you or your partner is obese and having trouble conceiving, come talk with us. We can help you determine whether lifestyle changes, fertility treatments, or bariatric surgery – or a combination of approaches – can help achieve your goals.